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CLINICAL HISTORY OF THE PATIENT

CLINICAL HISTORY OF THE PATIENT. 1988 Start of hemodialysis 1992 Septic events Recurrent staphylococcus aureus sepsis Vancomycin and Rifampicine treatment interrupted because of side effects Biologically persistant inflammatory status 1993 Cardiac symptoms Dyspnea at effort

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CLINICAL HISTORY OF THE PATIENT

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  1. CLINICAL HISTORY OF THE PATIENT • 1988 Start of hemodialysis • 1992 Septic events • Recurrent staphylococcus aureus sepsis • Vancomycin and Rifampicine treatment interrupted because of side effects • Biologically persistant inflammatory status • 1993 Cardiac symptoms • Dyspnea at effort • Edema of the lower limbs • Hepatomegaly • Systolic murmur at the aortic level

  2. DIAGNOSTIC DATA • Transthoracic Echocardiography • slight dilatation of the left ventricle • mild pulmonary hypertension • moderated stenosis of the aortic valve • Abdominal CT-scan • hepatomegaly • slight ascites • Follow-up TTE • right and left heart failure • shunt at the level of the main pulmonary artery • Transesophageal Echocardiography • confirmation of the shunt between ascending aorta and main pulmonary artery • Cardiac Catheterisation • pulmonary hypertension (51/26/33 mmHg) • pulmonary capillary wedge at 20 mmHg • cardiac output > 8,5 l/min • left-right shunt estimated at 2,7/1 • Angiography • shunt just above the coronary arteries • normal coronarography

  3. COMMENT • Etiology described in the literature • rupture of ascending aorta aneurysm • penetrating injury • aortoplasty for correction of ascending aorta aneurysm • Classification • Diagnostic criteria • Clinically • symptoms and signs of heart failure • ECG • combined or left ventricle hypertrophy • Chest Xray • cardiomegaly • augmented vascular markings • Specific study • transthoracic echocardiography • cardiac catheterisation • angiography • NMR

  4. SURGICAL REPAIR • Indication • without surgical correction the shunt leads inevitably to pulmonary hypertension and cardiac failure • General approach • cardio-pulmonary bypass • transaortic/transpulmonary/through the window • direct suture or patch • Technical particularities and advantages of the reported case • maximal excision of the fistula and its surrounding tissue • anatomical reconstruction of the aorta and the pulmonary artery • use of a vascular allograft

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